Provider Demographics
NPI:1598886335
Name:BENNETT, J. MICHAEL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:MICHAEL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8279 MAGNOLIA VILLAGE DR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-6237
Mailing Address - Country:US
Mailing Address - Phone:251-478-0758
Mailing Address - Fax:251-478-0758
Practice Address - Street 1:3207 INTERNATIONAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3020
Practice Address - Country:US
Practice Address - Phone:251-478-0758
Practice Address - Fax:251-478-0227
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20379183500000X
AL14492183500000X
TN22976183500000X
ARPD10051183500000X
KY013248183500000X
LA017989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist